CostAware Compares Health Care Costs Based on Delaware Medical Claims

NEW CASTLE (March 3, 2023) – The Delaware Department of Health and Social Services (DHSS) announced today the launch of a new version of its CostAware website, designed to help Delawareans understand how their health care dollars are spent by comparing the variation of average costs for different episodes of care and medical services based on actual medical claims in Delaware.

In early 2020, DHSS and the Delaware Health Care Commission began working with Delaware Health Information Network (DHIN) to develop and implement various health care cost and quality analyses. These analyses leverage data in the Delaware Health Care Claims Database (HCCD), which was established through legislation passed by the General Assembly in 2016. DHIN manages the claims database and DHSS uses it to inform and support a variety of policy initiatives.

The initial version of CostAware, launched in April 2022, compared hospital costs for several common episodes of care at six unnamed hospital systems: cardiac procedures, C-section birth, emergency department visits, knee and hip replacement, and vaginal delivery. The costs across five accountable care organizations (ACOs) are also compared for seven common services: blood count, colonoscopy, doctor visits, hemoglobin A1c, head CT, lumbar spine MRI and screening mammography.

In addition to the above data, this version of CostAware includes the following enhancements:

• Average cost estimates for episodes of care reported for named Delaware hospitals.
• Estimates of the average cost per visit for additional medical services, including child wellness visits, mental and behavioral/health services, diabetes care, cardiac investigations and procedures, doctor visits by complexity, and lab tests (blood and urine tests).
• Results reported by type of care setting (e.g., hospital outpatient facility, outpatient lab, professional office, urgent care facility, and telehealth) to facilitate additional comparisons.
• Additional years of data included – 2020 and 2021 were added to the 2019 data used for CostAware 1.0.
• Trend visualizations, with multiple years of data, show changes over time in average cost, quality, and other measures.
• Improved filtering of results by insurance category (Commercial, Medicaid, Medicare Advantage) and patient age range and gender (as appropriate).

“Since its launch last year, CostAware has served as a valuable tool in highlighting the variation in the cost, utilization, and quality of health care in Delaware,” said DHSS Secretary Molly Magarik, who is also a member of the Delaware Health Care Commission. “We are excited for these additional data enhancements, as they add yet another layer of transparency and awareness around the health care dollars that are spent by Delawareans and their insurers.”

CostAware also includes quality measures, including the readmission and utilization rates, and patient satisfaction scores, all from the Centers for Medicare and Medicaid Services (CMS) as part of its Hospital Compare and Medicare Shared Savings Program initiatives. Each episode of care and service can be filtered further by the type of insurance: commercial, Medicare Advantage and Medicaid.

Early in his administration, Governor John Carney said one of the most important things he could do as Governor is to slow the growth of health care spending. In late 2018, the Governor signed Executive Order 25, establishing a state health care spending benchmark, a per-annum rate-of-growth benchmark for health care spending, and several health care quality measures. The first spending benchmark went into effect on Jan. 1, 2019, and was set at 3.8%, with the target expected to decrease gradually to 3% over the following three years. The first benchmark report measured the growth rate at 7.8% for 2019, or more than twice the 3.8% target. This has proven to be an invaluable initiative, which lead to it being codified in 2022 through House Amendment 1 for House Bill 442.

The CostAware website was developed by DHSS and the Health Care Commission in collaboration with DHIN.

Congress sets April 1, 2023, as Medicaid renewal start date; Members should verify contact information with DHSS 

The Delaware Department of Health and Social Services (DHSS) will resume the standard eligibility renewal process for Medicaid and CHIP recipients starting April 1, 2023, as required by federal law. Annual renewals have not been required since March 2020 during the federal Public Health Emergency designation. Federal legislation, signed into law on December 29, 2022, set a specific date to resume renewals, regardless of when the Public Health Emergency ends.  

As of January 2023, approximately 310,000 Delawareans were enrolled in Medicaid. Once annual renewals begin, there will be Delawareans who were receiving continuous coverage due to the Public Health Emergency that will no longer be eligible for Medicaid. DHSS estimates 40,000 to 50,000 Delaware residents may no longer qualify for Medicaid or CHIP, also known as the Delaware Healthy Children Program, and may be disenrolled.  

“Over the past three years, the state’s public assistance programs have been a crucial safety net for so many Delawareans,” said Molly Magarik, Secretary of the Delaware Department of Health and Social Services (DHSS). “As we prepare for the monumental task of restarting eligibility renewals again, our goal is to ensure Medicaid members who continue to be eligible stay enrolled and that those who are determined to no longer be eligible get connected to affordable coverage.”  

The most important thing Medicaid and CHIP members can do right now is to update their mailing address, email and phone numbers with DMMA and sign up for electronic notifications. Contact the Change Report Center at (302) 571-4900, Option 2 or send changes via fax to (302) 571-4901. Changes and notification preferences can also be made at ASSIST Self Service, https://assist.dhss.delaware.gov/. 

“There are many Delaware residents who qualified for Medicaid coverage for the first time during the Public Health Emergency who have never had to complete an annual renewal before,” said Steven Costantino, Director of Health Care Reform for DHSS. “This is why it is critical that we have the most accurate information available for each member, and that individuals on Medicaid watch out for communication to avoid a potential disruption in coverage.”   

Between April 2023 and April 2024, DHSS will review every member’s eligibility and, where approved by state or federal rules, use available data sources to automatically renew members. If DHSS cannot auto-renew a person’s coverage using available and approved data sources, the member will receive a renewal packet by mail or a notification by email, depending on the selected preference.  

Delaware Medicaid and its Managed Care Organization partners will also use texts, email, and social media when available to enhance outreach efforts. A member will be able to complete the renewal packet through a variety of ways: Online, by phone, by mail, by fax, or at any Division of Social Services (DSS) office located within the Delaware State Service Centers. 

Health care providers and others who provide services to members can help by reminding their Medicaid members to look for and complete their Medicaid renewals this year and to encourage them to start exploring other coverage options if they believe they will no longer qualify for their current coverage. 

To help individuals who are no longer eligible for Medicaid coverage, the federal government has authorized a Special Enrollment Period for the Health Insurance Marketplace. Individuals who lose their coverage through Medicaid and CHIP any time between March 31, 2023, and July 31, 2024, will be eligible for a marketplace special enrollment period. After a person is determined eligible for the marketplace, they will have 60 days to choose a plan, and their coverage will start the first day of the month after the plan is selected.  

Many enrollees can find plans on the Health Insurance Marketplace that cost less than $10 a month. Plans cover services like prescription drugs, doctor visits, urgent care, hospital visits, and more. 

Assistance enrolling in the Delaware Health Insurance Marketplace is available from certified Health Insurance Marketplace Navigator teams at Westside Family Healthcare and Quality Insights. To be connected to a trained Navigator, call:  

• Westside Family Healthcare: New Castle County: 302-472-8655, Kent or Sussex counties: 302-678-2205 
• Quality Insights: 1-844-238-1189 

For more information, visit de.gov/medicaidrenewals. 

-30-

Delaware Health and Social Services is committed to improving the quality of the lives of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.

NEW CASTLE (Jan. 27, 2023) – With more choice in plans than ever before, enhanced federal subsidies, and Delaware’s reinsurance program keeping the cost of monthly premiums relatively steady, enrollment on Delaware’s Health Insurance Marketplace for 2023 again set an all-time high, increasing 8% over the open enrollment total for 2022.

During Delaware’s 10th open enrollment period, which began on Nov. 1, 2022, and ended Jan. 15, 2023, a total of 34,742 Delawareans enrolled for health insurance on HealthCare.gov. During the previous year, sign-ups during the open enrollment period totaled 32,113. For those who enrolled by Dec. 15, 2022, and paid their first premium, coverage began Jan. 1, 2023. For those who enrolled by Jan. 15, 2023, and paid their first premium, coverage will begin Feb. 1, 2023.

“All Delaware families need access to affordable, quality health care,” said Governor John Carney. “This year, we celebrated the 10th year of open enrollment on Delaware’s Health Insurance Marketplace with more plans to choose from, helping to make coverage even more affordable. With record-breaking enrollment numbers, we know Delawareans are prioritizing their health. Thank you to all the community navigators and health advocates who helped us reach this milestone.”

“Marketplace plans play a crucial role in improving access to high-quality and affordable health care,” said Department of Health and Social Services Secretary Molly Magarik. “I am thrilled to see a record number of Delawareans taking advantage of the many affordable options offered through Delaware’s Health Insurance Marketplace, and we are grateful to the community navigators and application counselors who worked hard during open enrollment to help individuals and families find the plan that was right for them.”

This year, Delawareans were able to choose from three insurers, compared to only one last year, and a total of 30 plans, the highest total in the 10 years of the marketplace. Insurance Commissioner Trinidad Navarro announced in June 2022 that two new insurers – AmeriHealth Caritas (four plans) and Aetna CVS Health (nine plans) – would join Highmark Blue Cross Blue Shield Delaware (17 plan options) in offering coverage on the marketplace for 2023.

All plans offer essential health benefits such as coverage of pre-existing conditions, outpatient care, emergency services, hospitalization, prescription drugs, mental health and substance use disorder services, lab services, pediatric services, birth control and breastfeeding coverage, and COVID-19 vaccines, including the updated bivalent booster. In addition, coverage cannot be terminated due to a change in health status, including diagnosis or treatment of COVID-19.

“Judging from the final enrollment numbers, it is clear that Delaware consumers appreciate being able to choose from a variety of plans at prices that are affordable,” said Insurance Commissioner Trinidad Navarro. “Affordable, high quality health care is critical to Delaware consumers, and market stability and increased competition are key to helping provide consumer-friendly health insurance options in Delaware.”

The overall stability of Delaware’s Health Insurance Marketplace reflects continued federal approval of Delaware’s reinsurance program. The program has lowered health insurance premiums for plans sold in the individual insurance market by partially reimbursing insurers for high-cost health care claims through a fund that uses a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. Because the insurers’ claims costs are lower, the insurers can reduce the cost of premiums or limit increases.

In 2021, the Biden administration made expanding access to health insurance and affordability a priority through the American Rescue Plan Act, which increased tax credits and expanded subsidies into the middle class. This year, the passage of the Inflation Reduction Act continued those enhanced benefits through 2025. For instance, a family of four (both parents in their 40s) making $50,000 are eligible for a credit of roughly $16,000, compared with $14,300 previously.

“Over a decade ago, when crafting the Affordable Care Act, we had one goal in mind: to make affordable, quality health care available to all Americans – and the marketplaces were vital to reaching that goal,” said U.S. Senator Tom Carper. “Now, we are seeing enrollment numbers go up year after year, and more Delawareans are able to get preventative screenings at no cost and get access to health care services previously not afforded to them. I thank the hard-working navigators for their work enrolling uninsured Delawareans in plans that work best for their families, and I look forward to continuing our work to drive down health care costs for all Americans.”

“Over the past decade, the Affordable Care Act has made affordable, quality health care coverage a reality for millions of Americans,” said U.S. Senator Chris Coons. “I’m proud to have worked with President Biden and my colleagues to strengthen the ACA in the American Rescue Plan and Inflation Reduction Act, further driving down costs for families, and am excited to see record numbers of Delawareans benefitting from this landmark legislation this year.”

“Ensuring that Delawareans have accessible, affordable, high-quality health care is critical to the health and well-being of communities across the First State,” said U.S. Rep. Lisa Blunt Rochester. “I am encouraged to see that this year a record number of Delawareans signed up for health care coverage through Delaware’s marketplace. This would not have been possible without the hard work of DHSS, Insurance Commissioner Navarro, and Community Navigators such as Westside Family Healthcare and Quality Insights that were on the ground guiding Delawareans and providing the resources they needed to find plans that fit them and their families best. I am grateful to be a partner in keeping Delaware healthy and remain as committed as ever in advocating for more affordable, accessible, high-quality health care for Delawareans in the 118th Congress.”

Delawareans who need help enrolling in coverage have access to free in-person assistance from federally funded and trained specialists at Westside Family Healthcare (statewide) and Quality

Insights, Inc., (New Castle and Sussex counties) and by certified application counselors at Henrietta Johnson Medical Center in Wilmington and La Red Health Center in Georgetown. Westside and Quality Insights each received increased federal funding for navigators to help people enroll for coverage.

“As a Federally Qualified Health Center, Westside understands how health insurance coverage reduces barriers to routine care and can save lives” said Lolita Lopez, President & CEO of Westside Family Healthcare. “Westside has provided enrollment assistance in the Health Insurance Marketplace since 2013, and we are thrilled with the record-breaking results during this open enrollment period. We commend the work of our state partners to reduce premium costs making coverage on the Delaware Health Insurance Marketplace more affordable than ever before.”

“We are very pleased to see a continued increase in those taking advantage of the affordable coverage offered through the Marketplace,” said Shanen Wright, Program Director of Quality Insights’ Navigator program. “And although 2023 open enrollment has concluded, we are available year-around to help Delaware residents learn more about their coverage options for 2024, or to enroll this year for those who become newly eligible through a qualifying event. We encourage anyone in need of information or assistance to reach out at qualityinsights.org/navigator or 1-844-238-1189.”

With the end of open enrollment on the health insurance marketplace, Delawareans can enroll for coverage if they experience a life event that qualifies them for a special enrollment period. Among the many qualifying life events are birth or adoption of a child, a permanent move, loss of other coverage through a job, and marriage or divorce. Visit HealthCare.gov/screener to see if you qualify.

In addition to the health insurance marketplace, some Delawareans might be eligible for coverage through Delaware’s Medicaid program, which is open year-round. To be screened for eligibility or to apply for Medicaid benefits, go to Delaware ASSIST.

Experienced healthcare management strategist hired after lengthy national search

Insurance Commissioner Trinidad Navarro welcomed Cristine Vogel to the Delaware Department of Insurance as its Director of Value-Based Health Care Delivery this week after a lengthy national search to fill the role. As the inaugural Director, Vogel will lead efforts that relate to value-based care, primary care, pharmaceuticals and pharmacy benefit managers, affordability, and other health-policy initiatives including grant programs.

“It is more important than ever before to ensure the accessibility and affordability of healthcare and prescriptions,” said Commissioner Navarro. “Hospital prices, the cost of medications, and low-quality services all raise the price of consumer care and insurance coverage. With Cristine’s expertise on board, we can keep making progress toward higher-quality care at a lower cost.”

Director Vogel has been involved with healthcare management for over 25 years, with experience in hospitals and medical practices, state government, insurance, and consulting. Leading the Office of Value-Based Health Care Delivery, Vogel will establish, implement, and monitor Affordability Standards such as those to increase primary care investment, and manage the reporting of carrier investments in health care. This will include assessing commercial reimbursement rates for primary and chronic care services, the role of price and utilization in healthcare spending, and prescription drug spending as a driver of total cost of care.

“Delaware is taking on innovative efforts to address care quality and cost, and I’m proud to work with Commissioner Navarro to make these projects a success,” said Director Vogel.

Vogel most recently served as the Director of Population Health Initiatives for Nuvance Health System in Connecticut, where she developed solutions to improve clinical outcomes, increase quality of care, and control healthcare costs through implementing a nurse care management program, a clinical pharmacy program, and through integrating behavioral health within primary care practices. Her experience in healthcare reform also includes leading the State of Connecticut’s Office of Healthcare Access and evaluating Certificates of Need. The position, funded by the department, was made necessary by several legislative mandates related to healthcare affordability and pharmacy benefits.

Following in-depth reviews by independent actuaries and the Office of Value-Based Health Care Delivery, rates for regulated 2023 health, dental, and small group insurance plans were announced today. While premiums are rising steeply across the country, the extension of consumer-friendly subsidies through the Inflation Reduction Act, coupled with Delaware’s strong 2022 enrollment and 2023 Health Insurance Marketplace expansion, will limit consumer impact locally.

“This year, Delaware consumers have more carriers and plans to choose from than ever before, so they can find an affordable plan that meets their needs. We remain optimistic that this increased competition will lead to lower rates and higher care quality over time,” said Insurance Commissioner Trinidad Navarro. “Delawareans are facing rising costs in nearly every area of life and making difficult sacrifices to afford necessities – but let me be clear, no matter the financial cost, we cannot afford to sacrifice our health. We will continue to work to ensure that coverage is affordable and accessible to all residents.”

Two new health insurers will be joining the Marketplace for 2023. Before tax credits and subsidies, base rates for 21-year-old non-tobacco users range from $315 to $505 across 9 Aetna CVS Health plan options, and from $283 to $402 with AmeriHealth Caritas across 4 plan options. Returning ACA issuer Highmark Blue Cross Blue Shield of Delaware will be increasing rates 5.5% on average, with base rates for 17 plan options ranging from $249 to $618 including a catastrophic plan option. In the last few years, Highmark’s average rates have decreased roughly 10% despite this needed increase.

Plans on the marketplace are spread among metal-level categories – bronze, silver, gold, platinum and catastrophic – and are based on how enrollees choose to split the costs of care with their insurance company.

As always, Commissioner Navarro urges residents to be informed consumers and shop for the best plan for both their needs and their budget. 30 plans are available to Delawareans for the 2023 plan year, and local navigators are available to assist in choosing the right plan. Open Enrollment takes place November 1 through January 15.

Factors Involved in Expansion, Rates

Nationally, insurers are requesting increases due to inflation, increasing costs of care, and rising drug prices. In Delaware, both state and federal legislation contributed to the long-awaited carrier expansion and final rates.

“It’s no coincidence that Delaware was able to expand the number of carrier options on the Health Insurance Marketplace in the same year that laws limiting hospital price growth to appropriate, inflation-conscious levels became enforceable,” said Commissioner Navarro. “The hospital price growth law, for the first time in our state’s history, gave insurers leverage to negotiate lower costs for consumers while still ensuring that hardworking healthcare providers receive their fair share. We’re grateful to have worked with legislators and the Primary Care Reform Collaborative to put cost containment guardrails in place to curtail rising consumer expenses, encourage carrier expansion, and ensure the effectiveness of every dollar spent.”

With little financial limitations around hospital prices, private insurance plans pay the price – on average 224% more than Medicare plans, according to RAND Corporation.

During the rate filing process, questions also remained about the expiration of American Rescue Plan Act subsidies, which the department lobbied Delaware’s congressional delegation to extend. These subsidies lowered consumer costs significantly and contributed to the state’s largest-ever ACA enrollment, a year-over-year increase of 26.8%. Had these benefits expired, healthy consumers who were influenced to acquire coverage through the enhanced discounts may have left the marketplace, shrinking the risk pool and unbalancing rates. On August 16, President Biden signed the Inflation Reduction Act into law, extending subsidies into 2025.

Aside from potential enrollment increases due to the carrier expansion, future participation growth may come from Medicaid unwinding and income eligibility reviews. National efforts are underway to ensure smooth, affordable transitions to Marketplace coverage for those eligible.

Other ACA and ACA-Compliant Rates

Delta Dental will reduce both ACA and non-marketplace rates by an average of 4%, and Dominion Dental will increase ACA premiums by 2.2%. Metropolitan Life Ins. Co.’s small group non-marketplace dental plan rates will remain at their current level.

Returning off-market small group plans from Highmark will increase an average 2.4%, Optimum Choice plans will rise by 2.7%, and United Healthcare small group rates will increase by 2.8%. Aetna Health’s small group plans will increase 7.6%, and Aetna Life rates will increase 5.1% after an initial increase request of 8.8% was reduced. Aetna Health’s 9 off-marketplace individual plan rates will remain at their current level.

About ACA Plans

All ACA-compliant health plans offer essential health benefits, including coverage of pre-existing conditions, prescriptions, emergency services and hospitalization, mental and behavioral health coverage, outpatient care and telehealth, lab services, and more.

Open enrollment for 2023 Health Insurance Marketplace plans begins November 1. Residents may qualify to enroll or change plans based on special circumstances, such as income qualification, loss of health coverage, becoming a parent, or other qualifying factors throughout the year. Find out if you qualify for special enrollment.

Commissioner Navarro announces Health Insurance Marketplace expansion

Be aware of non-compliant alternative health plans